Lee says:

Yes, it’s the same thing! Hormones decrease fertility but don’t 100% guarantee that fertility is eliminated fully. 

If someone has a uterus and ovaries, they can become pregnant if they have sex with someone with a penis and sperm. 

This is true whether or not the person with the uterus and ovaries is on testosterone, or the person with a penis and sperm is on estrogen; reduced fertility is not the same thing as total sterility.

The only exceptions are if either person has had surgical sterilization, like a vasectomy or tubal ligation, or if the person with a uterus and ovaries is using contraceptives to prevent pregnancy like if they have an IUD placed, or if a barrier method is used like an external (“male”) condom worn on the penis, or an internal (”female”) condom placed in the vagina.

Please talk to your partner about this! If you haven’t been sterilized or aren’t using birth control/contraceptives yourself, don’t assume they they are using contraception or assume they’re infertile. Regardless of your gender or your parts, you need to be responsible and confirm that y’all are having safe sex. Also remember that STIs can be transmitted regardless of whether someone is getting pregnant!

Options to prevent pregnancy if you’re on T include:

What are the WPATH criteria for getting a hysto/oopho?

Options to prevent causing pregnancy if you’re on E include:

What are the WPATH criteria for getting an orchiectomy?

If you want more info on contraceptives or options to prevent pregnancy, I’d recommend that you talk to you doctor or go to Planned Parenthood to discuss what your options are!

If you don’t want a kid, use contraception because otherwise accidents happen! But if you do want to become pregnant/get your partner pregnant while you’re on hormones, you... still need to use contraception.

That’s because if you plan on getting pregnant you have to stop HRT first because taking HRT while pregnant might cause birth defects in your unborn baby.

Similarly, the effects of estrogen on sperm aren’t fully known, so it’s recommended you stop HRT before you start trying.

So in general, whether or not you want to have a child, you need to make sure you’re planning with a doctor to find a safe and healthy way for you to conceive, which might mean both of you temporarily stopping HRT.

Some helpful links:

Testosterone decreases your biological fertility and it stops menstruation. But even if your period has stopped, there’s still a chance that you can get pregnant, even if the chance is much lower than it would be otherwise.

There’s a study that says that being on T for one year doesn’t decrease fertility after you stop taking it, but there’s no research about whether being on T for years will affect fertility when you stop taking it.

You may want to look into freezing your eggs if you’re interested in having biological children. If oocyte preservation is desired, that should be pursued before you start T.

Similarly, people on estrogen should consider saving sperm if they want to ensure they can have a child. Estrogen causes decreased sperm production and less ejaculate, and some people do find that they are permanently infertile after hormones.

Because you can’t predict what will happen to you, if you really don’t want to take that risk you have to act preemptively if having a biological child is important to you. 

If you do want to have a kid, we have some other resources on pregnancy/being a trans parent that you may find helpful, but that’s another post!

TLDR; HRT is not birth control and you still need to use birth control if you have the kind of sex that could cause pregnancy

Ryn says:

Only in bad science fiction. Because I’m a biologist, I’ll put some more below the cut for those who feel like reading it. CW for medical terminology, other triggers are tagged. 

Lee says:

Hi there friend! If you have anyone in your life who you trust, who understands what it’s like to have dysphoria and/or mental illnesses, and who you think would understand what you’re going through, I’d reach out to them and get their advice. 

Whether that’s a family member, friend, doctor, therapist, or someone else in your life, it can be good to get an outside perspective. But in the end, this is your body and it is your choice. Whatever choice you make is valid.

I’ll note here that being trans doesn’t mean you can’t want to carry a child! There are lots of trans people out there who really want to carry their own child, and it doesn’t make them any less trans:

Laws are slowly changing to recognize the potential for transgender parents as well. For example, there’s trans couple who had a child together in Illinois, and while the trans woman was going to be put down as the “Father” and the transmasculine person who birthed the child was going to be put as the “Mother” on the birth certificate, they were able to get their gender listed correctly in the end.

I know of a few Tumblr blogs by trans folk who currently are pregnant or have been pregnant in the past:

Being a trans parent is possible, and it can also come with some dysphoria along the way. If you really want to be pregnant, you can try to figure out strategies to cope with this dysphoria.

But of course, not everyone wants to be pregnant. This is true for a lot of people, for a lot of reasons. Maybe you do want to have a baby, but you’re just not ready to have a baby right now and you want to have more financial security before you take that step. Or maybe you want to have a baby, but not until you’re ready to deal with the mental health fallout of going through pregnancy, and have a therapist, psychiatrist, and support system in place. Maybe you don’t know if you want to have a baby some day, but you do know you don’t want to have a baby right now. Maybe you never want to have a baby. That’s okay too. I personally got a hysterectomy- I know that having a child is something that will never be right for me. 

If you don’t think you want to go through with this pregnancy, that’s also okay and valid. I am firmly pro-choice, and I’ve driven people to Planned Parenthood to get an abortion. I know there’s a lot of reasons someone might not want to carry a pregnancy to term, and control over our bodies is thankfully our right in America. Getting an abortion is okay. It’s okay to have conflicting feelings about it, to know it’s the right choice for you and still be sad. And it’s okay to not care at all, or to be happy. There’s no one wrong way to feel about it. 

I reblogged this post by Planned Parenthood earlier for you. They said:

The confusing way pregnancy is calculated, six weeks pregnant is two weeks after you miss your period. Pregnancy is a big decision, and it’s also one with a timeline- you can’t take months to figure out what you want to do, you have to make up your mind before you’re past the point of being able to access an abortion. 

So if you’re having major doubts about going forward with the pregnancy, and you think that it might be harmful for your mental health, then I’d call Planned Parenthood (or a similar group) now and schedule an online appointment just to find out what your options are now that the coronavirus has changed how people usually access care. Reaching out for an appointment means you can discuss your options- it doesn’t mean you are then obligated to have an abortion if you aren’t sure about it.

And again, it’s possible to get an abortion now if you don’t think this is the right time for you to have a baby, but still choose to get pregnant again at some point in the future when you’re feeling more prepared and stable.

Whether you decide to get an abortion now or carry the pregnancy to term, your mental health is important. Both of those choices (and even having to make that choice) can be rough on your mental health, which is normal and valid. There are a lot of therapists who are doing telephone or video appointments right now, and I’d see if getting a therapist is a possibility for you. Our Mental health page has some info on that.

I wish you the all best! You are really strong, and you’ll make it through to the other side of this.

Lee says:

Note- their website says “It’s not known if NEXPLANON is as effective in very overweight women, because clinical studies of NEXPLANON did not include many overweight women.”

Planned Parenthood has info on the different types of birth control options in this link, so I’d check that out as the starting place for anon’s search because it lists how effective each method should be- but ofc not everything will work with testosterone, so you may want to avoid estrogen-based options.

Options to prevent pregnancy if you’re on T include:

If anon wants more info on contraceptives or options to prevent pregnancy, I’d recommend they talk to their doctor or go to Planned Parenthood to discuss what your options are!

Lee says:

No, sadly a birth control pill isn’t an option currently commercially available for cis men. But one has been developed- it just isn’t on the market yet, and probably won’t be within the next 10 years.

Cis men have two options:

Trans men have a few different options:

If you want more info on different contraceptives or options to prevent pregnancy, talk to your doctor or go to Planned Parenthood to discuss what your options are!

Followers say:

demiiboy said: Progesterone based (ie implant, depoprevera) is okay too, according to my pp. I’ve been on depo for 4 years and testosterone for 5months. No affect on the speed of my physical transition

Lee says:

The Testosterone FAQ has a Can I get pregnant when I’m on T? link which answers that question.

Basically, the answer is never. He will never be on testosterone long enough that he can have unprotected vaginal sex without the risk of pregnancy because testosterone isn’t a contraceptive.

Testosterone reduces biological fertility, but it doesn’t eliminate it entirely. So even when his periods have stopped, there’s still a chance that he could get pregnant. It’s a smaller chance, but it’s still a high enough risk that you need to be using something else to prevent pregnancy instead of relying solely on T. 

If you want to avoid the possibility of him getting pregnant, you will always need to use birth control or a condom or some other method of contraceptives. Testosterone doesn’t change that.

Some trans men have gotten pregnant even when they weren’t having their periods and were still taking testosterone because testosterone doesn’t completely stop egg production, so some guys will still release eggs even on T and even without a period.

I got a hysterectomy about a year and a half ago, which means I’ll never have to worry about pregnancy even if I wasn’t with my AFAB partner. It also has the benefits of never getting another period even if you stop T, and allowing you to get a vaginectomy and urethral lengthening if you want lower surgery in the future. So if he never wants to have kids, a hysterectomy can be a solution to that worry.

Similarly, you could get a vasectomy if you don’t ever want to father children.

Other ways of preventing pregnancy:

TLDR; Testosterone isn’t birth control. You and your boyfriend should talk to his doctor about finding a method of birth control that will work for him.

Followers say:

demiiboy said: Progesterone based (ie implant, depoprevera) is okay too, according to my pp. I’ve been on depo for 4 years and testosterone for 5months. No affect on the speed of my physical transition

Lee says:

That’s a big question, and there isn’t a simple answer to it.

Testosterone might decrease fertility for some people, and that’s a warning that doctors usually give you because there isn’t enough research that says your fertility will be completely unaffected.

There’s a study that says that being on T for one year doesn’t decrease fertility, but there’s no research about whether being on T for years will affect fertility when you stop taking it.

So if having biological children is really important to you, how testosterone may affect your fertility is something you should discuss with your endocrinologist before you start T.

There are many people who stop taking testosterone and then their fertility returns and they are able to birth their own children. There are other people who choose not to risk it, and freeze their eggs before starting testosterone or wait to start T until they’ve had a kid. 

You may want to look into freezing your eggs if you’re interested in having biological children and you can afford the cost- it’s pretty expensive. If oocyte preservation is desired, that should be pursued before you start T.

Again, it is 100% possible to get pregnant after being on T, and there are some people who have stopped taking T to get pregnant and were able to conceive.

But it is simultaneously true that we don’t know exactly how much it might reduce fertility, especially if you try to conceive after having been on T for many years starting at a young age. T may reduce fertility by only a tiny bit but we just don’t know yet, so it’s up to you to decide if that’s a risk you’re comfortable taking.

If you plan on getting pregnant and you’re on T, you’ll have to stop testosterone before you start trying because taking testosterone while pregnant may cause birth defects in your unborn baby. 

Again, you can’t be on testosterone when you are trying to conceive a child, and you can’t be on testosterone during pregnancy. But you could be on T before you start trying, and that may possibly affect your fertility and it may not.

More info on fertility is here:

Lee says:

On mobile go to your web browser like Chrome and type transgenderteensurvivalguide.tumblr.com/faq and please read the FAQ before you send us an ask!

And wouldn’t ya know it, our Transmasculine resources, which is linked to in the faq, has a Testosterone FAQ page, which answers that question:

So if you know how to navigate the FAQ you’ll find that we actually have links to resources on a ton of topics, so always take a peek there!

Lee says:

If you want to be able to breastfeed for sure, then don’t get top surgery until after you’ve had a child. Getting top surgery makes it way less likely you’ll be able to breastfeed, and if you’re not comfortable with the possibility that you won’t be able to breastfeed then you’ll want to wait.

I’ve heard of trans men who have been able to, but haven’t been able to produce enough milk to feed the child on that alone, they also need to supplement it with other things, like formula or donated milk. So if you ask the surgeon to leave your milk ducts in, you may be able to produce some milk.

Even a breast reduction may compromise the ability to produce enough milks to exclusively breastfeed:

If carrying your biological kids and breastfeeding them yourself without supplements is really important to you, then you may want to hold off on top surgery until after you’ve done that. It’s possible to breastfeed after top surgery, but I wouldn’t count on it. But if you don’t mind not being able to breastfeed them fully, then it’s possible to get top surgery before becoming pregnant.

People usually don’t report significant breast re-growth during pregnancy because most of the tissue that could grow has been removed, but sometimes there’s a small increase in chest size which tends to return to normal sometime after the pregnancy is over. If you do experience some chest growth during pregnancy, it should return to normal after and the skin should shrink down, but if it doesn’t then you may need a small revision surgery.

You should discuss all this with a top surgeon during your consultation and see what they have to say before you make your decision on whether you want surgery before pregnancy or want to wait until after pregnancy.

Followers say:

queermicah said: This can depend. My friend has had top surgery is currently producing milk for their baby due in December. Most surgeons that I know of try to preserve the milk ducts if requested and just take the tissue but it’s not known until the situation arises if it’s possible- sometimes it isn’t even if they tried to preserve the milk ducts

cosmicthey said: If you can’t but still want the bonding experience there are ways to simulate chestfeeding using formula and some tubes. If you can produce milk it may also be difficult for them to latch on.

Lee says:

Yes, it’s okay! I know a trans guy who put off getting phallo until after he had his kids, and then he got surgery.

You don’t have to live your life following the stereotyped expectations that other people have about what a trans man would or should do. You should do what you want to do, and if having a kid is something that’s important to you then that’s what you should do.

If you want to transition in some ways that won’t affect fertility, you can always take some steps like coming out, binding (which shouldn’t impact breastfeeding later in life), cutting your hair, wearing men’s clothes, voice training to lower your voice, socially transitioning and generally presenting as male, etc.

Testosterone decreases your biological fertility and it stops menstruation. Both typically return to pre-T levels after a few months if you stop taking T, but there is a risk of reduced fertility that you should discuss with your endocrinologist before you decide to take T. You may want to look into freezing your eggs if you’re interested in having biological children after T. If oocyte preservation is desired, that should be pursued before you start T. You can still get pregnant on T, although it’s less likely to happen than if you were not on T. If you plan on getting pregnant you have to stop testosterone because taking testosterone while pregnant can cause birth defects in your unborn baby. Check out the If you can’t start T link if you want to try to get some similar changes but without starting T.

Wanting to have a child of your own doesn’t necessarily mean that you want to breastfeed them yourself. If you want to be able to breastfeed for sure, then don’t get top surgery until after you’ve had a child. Getting top surgery makes it way less likely you’ll be able to breastfeed, and if you’re not comfortable with the possibility that you won’t be able to breastfeed then you’ll want to wait. I’ve heard of trans men who have been able to, but haven’t been able to produce enough milk to feed the child on that alone, they also need to supplement it with other things, like formula or donated milk. But top surgery doesn’t affect fertility- just the ability to breastfeed.

But yes, it’s 100% valid to postpone your medical transition until after you’ve had a child and it doesn’t make you any less trans or any less of a man.

The theme of today (and forever) is do what you want to do, do what will make you happy, and you’re still valid so don’t restrict yourself and take away your own happiness because other people are ignorant or transphobic.